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, , O,�Q�O City of Orono ` °F CIT ONLY <br /> P.O.Boa 66 Date Received: Permrt#� �� <br /> �� 2750 Keqey Parkway <br /> k� `r � Crystal Bay,MN 55323 Amount: 3•�C.U.P Filed: <br /> ������' (952)249-4600 � ' <br /> ��;Os� Approved By: MG+�Ti�U Site P3an: <br /> Recommends: A roval Denial ❑ : <br /> CITY OF ORONO - USER DEFINED/GENERAL PERMIT <br /> (All pertnits must Ue approved by the Building O�cial and/or Zoning Department) <br /> Job':Site,/Owner=Ixiformat�on ; <br /> Site Address: '��'f'�` ��-� �"�'^�L <br /> Owner: �/�..R—T�E���. Mailing Address: �S� �- phR..tC,. C.�'£_ <br /> City: _ Q2 0,.� e� Zip: SS3S� <br /> Home Phone: !P( a. � �l o -3''S Y�I Alternate Phone: <br /> -�— <br /> Gonfiractor%�p�licant I�£orniahon � <br /> Contractor/A �SZt� K-i.�t Contact Person: ���f'�" ��f° �S <br /> PP• <br /> Address: Q•�� $oX o�� State License#: <br /> City: �'h� Zip: -�'S';�s Expiration Date: <br /> Phone: QSZ- 3�+�-- �D3o Alternate Phone: Ea/a� �Y�� 313�' <br /> " ` �`' ,..'T3'PES�OF�US�'R�D�FIN,Ely�PER1VII`T5 :� .�# .�` <br /> � Stairway to Lake ❑ Retaining Walls ❑ Temporarv Trailer <br /> General—User Defined Surcharge General—User Defined Surcharge Genenl—User Defined <br /> * (Per UBC) * (Per UBC) *$30.00 <br /> *Estimated Cost:$ i2�po a *Estimated Cost• $ <br /> ❑ Docks-42"or Greater ❑ Land Alteration ❑ Zoning Review <br /> General—User Defined Surcharge General—User Defined General—User Defined <br /> ❑ Commercial-(Per UBC) ❑ 0-500 Cubic Yards *ForO-75'Zone-$30.00 <br /> *Estimated Cost: $ $50.00 (Needs Site Plan) <br /> General-User Defined ❑ 501+Cubic Yards <br /> ❑ Residential- $30.00 550.00 (tveeds C.u.P.) <br /> ❑ Tree Removal <br /> General—User Defined <br /> *Within 0-75' -$30.00 <br /> I herby apply for a User Defined Permit and I acknowledge that the information above is complete and <br /> accurate;that the work will be in conformance with the Ordinances and Codes of the City and with the State <br /> Building Code;that I understand this is not a permit and work is not to start without a pernut;and that the work <br /> in accordance with e proved plan. <br /> �/2��04' <br /> Applicant Date <br /> 7User�De6eed Permit 3/18flLtl <br />